Key Benefits:
Integrated implementation of the basic health insurance scheme for urban workers in the town and city of Hunami (Adopted at the 35th ordinary meeting of the People's Government of King and Special City on 25 March 2011, No. 1 of the Order No. 1 of 11 April 2011 and No. 1 of the People's Government Order No. 1 of 10 July 2011)
Chapter I General In order to enhance the integrated level of basic health insurance for urban workers, the capacity of the Basic Medical Insurance Fund for Town Employers to combat risks has been strengthened, the level of health insurance treatment is further improved and the medical treatment of insured persons is facilitated by the development of this approach in line with the Social Insurance Act of the People's Republic of China and the relevant legal provisions. Article 2 (i) The funding standards and the level of safeguards for basic health insurance for urban workers are adapted to the level of economic and social development; (ii) Integration of the basic health insurance at the municipal level, standardization of fees in municipalities and flag districts, harmonization of the level of insurance treatment, harmonization of the process and harmonization of information systems. Shared management and responsibilities at the primary and flag levels of the Medical Insurance Fund; (iii) To uphold the principle of a combination of social cohesion and individual accounts by co-payments units and individuals. Article 3 State civil servants have access to health assistance policies based on their participation in basic health insurance. In the context of participating in the basic health insurance, the participating enterprises may be able to establish additional health insurance for their workers. Complementary health insurance costs are covered by a total of 4 per cent of the salary, from the employee welfare fee and the portion of the underfundament of benefits, and are included at the cost after approval by the same financial sector. The Supplementary Health Insurance Fund is administered by the participating companies themselves. Article IV Employers should participate in large-scale health insurance at the same time as the basic health insurance. Article 5 (i) Various types of enterprises (including townships registered and operated in towns) and their employees; (ii) State organs, business organizations, social groups and their employees; (iii) Civil service units and their employees; (iv) Individual economic organization operators and their practitioners; (v) External workers who have entered into labour contracts with the user units; (vi) Flexible employment; (vii) Other units and persons provided for in law, regulations. In the city, units such as the Integral Enterprise, the Self-Autonomous Region are owned by businesses and the Correspondent Railway Authority and their employees are integrated into the basic health insurance for their workers in the city, in accordance with the principle of territorial management. The human resources and social security sectors of the city, the flag district are the authorities responsible for health insurance in the city. The municipal and flag-based health insurance agencies are specifically responsible for the work of the health insurance operations in the current territories. The relevant sectors of development reform, finance, health, medicinal regulation, audit, business and business are coordinated with the implementation of this approach in line with their respective responsibilities. Chapter II Article 7. The participating units shall terminate the basic health insurance relationship under the law or change in the registration of basic health insurance matters, and shall, within 30 working days of the date of termination or change, be transferred to the occupancy or change procedures of the PSIL. Article 8 The initial insured person pays the basic medical insurance fee at his monthly salary. Article 9. Basic health insurance expenses are paid jointly by the user unit and the worker, and are paid by the individual insured persons such as flexible employment. The annual wage income for workers is less than 80 per cent of the average annual salary of the workers in the current city, 80 per cent of the average salary of the employee in the current city as a contribution base; and more than 30 per cent of the average salary of the employee in the current city, not as a contribution base. (i) The total annual salary of all workers in the insurance unit is based on a total of 6 per cent of the basic health insurance rate. (ii) The unit of the insured person is based on his annual salary income and pays a basic health insurance fee of 2 per cent, which is paid by the unit from the salary. (iii) An average salary of 80 per cent to 30 per cent of the individual insured person in the current city for the first-year-year-old employee can be paid in conjunction with a standard of 8 per cent of the above-mentioned user units and the worker's pension; and a basic health insurance fee may also be paid in accordance with the standard of inpatient hospitalization of 4.5 per cent. As economic development and wage income increase, the rate of payment for basic health insurance can be adjusted accordingly, as approved by the Government of the city. Article 10 Basic health insurance expenses shall be paid by 15 a month, or may be paid in a quarterly and annual manner. Article 11. Insolvency is declared by law, priority should be given to the payment of basic medical insurance fees and, at the time of liquidation of assets, 80 per cent of the average annual salary of the employee in the current city, with a set-up proportion of the basic health insurance expenses for the active worker for one year. Article 12. The Integrated Fund for Basic Health Insurance implements the management approach of “Emergency at the municipal level, sub-management, planning control, quantification”. The provision for basic medical insurance fees for urban workers, major health insurance fees and public service medical benefits is administered on a level of income and expenditure. Article 13 establishes an integrated fund for basic health insurance for urban workers. The pyrethroid was distributed by 5 per cent of the annual basic health insurance payments in each flag district, and the city's current level was dropped by 2 per cent. Removals were suspended at 15 per cent of the revenue earned by the municipal adjustment fund. The mediator was not able to distract in a timely manner, and the end-of-au-au-au-first-war rejection regime was introduced. Article 14. The principle of a combination of risk couriers with local responsibilities is upheld in terms of inadequate payment of integrated funds across the city. The integrated fund gap was addressed by the local calendar year balances fund and was not partially resolved by the facilitators. Article 15. The municipal health insurance agency is responsible for the management of the agent's funds, the establishment of an internal audit system and the regular publication of the balance of payments of the mediator. The pyrethroids are included in the management of the city's Principal Finance, with separate accounts and earmarked funds. Article 16 provides that basic health insurance expenses cannot be paid, and no unit or individual shall be refused or paid for any reason. Chapter III Basic health insurance treatment Article 17 Persons participating in the basic medical insurance of the urban workers reached the national legal retirement age, with the payment of the following-year limit and no payment of basic health insurance expenses: (i) Persons insured by 31 December 2004 are not less than 12 years for a continuing payment period. (ii) Persons insured for the period from 1 January 2005 to 30 November 2009, which are not less than 15 years. (iii) Persons who were insured after 1 December 2009 are not less than 20 years of continuous payment. Article 18 (i) Retirement of the insured person with an average salary of 80 per cent of the employed workers in the current city and 6 per cent of the basic health insurance fees remaining for the remainder of the year by the insured unit. (ii) The retirement of an individual insured person with an average salary of 80 per cent of the employee in the current city, at 6 per cent of the basic health insurance expenses for the remainder of his/her one-time contribution. (iii) A one-time payment confirmed a difficult individual participant, which could be treated with the benefit of a retired person on an annual basis, in accordance with the pay rate of the current employee. Revenues are no longer paid after the remainder. Participants of labour relations should be removed from the former units, and health insurance should be processed within six months of the dissolution of the labour relationship, with annual insurance payments for consecutive periods. The failure to do so was seen as re-insecution. Until the date of the reinstatement of the insured person's contributions was consolidated. Article 20 establishes six months waiting period for the initial participation of a unit of the basic health insurance for workers in the town. Since the date of admission or re-entry, the basic health insurance treatment can be enjoyed by the remaining six months. Individual accounts were not divided during the waiting period. Those involved in the movement of employment within the scope of the city do not have the waiting period, and the payment period is combined. Article 21 Specific criteria for the payment of the Integrated Fund for Basic Health Insurance are as follows: (i) For the first time in-patient medical institutions, the first inpatient medical treatment fund has been paid at a one-year rate of US$ 500 in hospitals such as 3A and US$ 300 in three hospitals, tier II, etc. (ii) A maximum of $1.9 million for medical expenses paid within a year of the Integrated Fund for Basic Health Insurance. Individual burdens are partly in line with the provisions of the major health insurance-related supplementary insurance, which is repaid in proportion to the prescribed rate. A maximum annual payment limit for the General Medical Insurance Fund amounted to $1.2 million. (iii) The above-mentioned standard of payment for the Integrated Fund and the maximum payment limit is in accordance with the policy-mandated portion, which is paid in proportion to the proportion indicated in the table below, and the rest is paid by the individual insured person.
The standard of payment, the proportion of payments, the maximum payment limit is adjusted to the annual average wage changes for the employee and the savings of the Fund. During the hospitalization of the insured person, a medical treatment project for the payment of part of the medical treatment covered by the Pharmace and the basic medical insurance was used by the medical directory, with the approval of the CNES, for which costs were paid by 10 per cent himself, while the remainder was paid by the Integrated Health Insurance Fund and individuals. During the rescue period, the occupants may use blood products, eggs, but the approval process should be completed within five working days after their use. Its costs were paid by individuals for 20 per cent, while the remaining portion was paid by the Integrated Fund and by individuals. A one-time special medical material is subject to a limited management. The one-time special medical material used during the hospitalization of the insured person was paid by a person for 10 per cent, while the remainder was paid by an integrated fund and by individual. More than $3000, the cost should be approved by the IMS. Article 23, which is limited by technical, equipment conditions, diagnosis is unknown or treatment difficulties are required to be transferred to other targeted medical institutions in the city for hospitalization, and medical expenses incurred before and after the referral are settled at a hospital fee. In the case of medical technology, equipment conditions limited to the hospital in N Mongolian hospitals, the first subsidiary hospital in the Home Mongolian Medical School and the medical facility in the interior Mongolian Hospital, diagnosis is unknown or treatment is required to be transferred to the hospital in the field, with the advice of the medical institutions referred to above, and the hospitalization of hospitalization treatment for basic medical insurance at the level of the overseas province has been approved by the IRS. The medical expenses incurred in line with the coverage of the Integrated Health Insurance Fund are reimbursed by the medical insurance certificate, the social security card, the referral certificate, the medical material, the cost summary, the diagnostic certificate, the medical cost settlement voucher to the occupancy insurance agency. The proportion of payments made by the Integrated Fund for Basic Health Insurance decreased by 10 per cent on the basis of article 21, paragraph 1 (c). Article 24 The medical costs incurred were incurred, with the relevant voucher to the IRS. The proportion of hospitalization payments is implemented in accordance with the standards of hospitalization in this city. The medical cost reimbursement rate is required to be treated at the referral level, in accordance with the standards for hospitalization in the field hospital. Article 25 In the event of acute illnesses during public missions or visits, the insured person should be given to the public hospitals at the district level for referrals, and the relevant voucher may be sent to the occupancy health insurance agencies. The medical reimbursement rate is implemented in accordance with the standards for hospitalization in the field hospitals. Article 26 Participation in the insurance unit and the insured person have paid the basic medical insurance fee, which has ceased to enjoy basic health insurance treatment and separate accounts as of the month of the payment; the contributions of the insured units and the insured persons within three months have been reinstated for the return of the basic health insurance treatment to the individual accounts. In excess of 6 months for less than three months, the insured units and the insured persons were added to the personal accounts after the payment was made as required, and the contributions were calculated on a continuing basis and the medical costs incurred during the period owed were not paid. Chapter IV Article 27 The Basic Health Insurance Fund for Urban Employers comprises the Integrated Fund and the Personal Account. The integrated funds and individual accounts shall not be accounted for separately, and the specific approach is as follows: (i) Accompanied unit, whose basic health insurance payments are all transferred to the individual accounts in accordance with the Unidroit; the basic health insurance payments paid by the insurance unit are divided into two parts, partly for the establishment of an integrated fund and the other part is transferred to the individual accounts according to the prescribed proportion. (ii) Individuals insured in conjunction with the Unified accounts, the basic health insurance payments paid by them are added to the Integrated Fund in addition to the individual accounts according to the proportion specified. (iii) In accordance with the integrated inpatiently insured individual insured persons, the basic health insurance payments paid by them are fully transferred to the Integrated Fund and do not have an individual account. The Twenty-eighth Integrated Fund is mainly designed to meet the medical costs incurred by inpatient care or emergency medical care, as well as the special chronic medical costs approved. The basic health insurance coverage, inspection, treatment must be strictly enforced in the national and self-government districts, the directory of the medical treatment project and the scope and payment criteria for the medical services facility, which exceeds the “three catalogues” fund for medical costs. Article 29 defines the percentage of individual accounts in accordance with the same age, according to the pooled personnel, as follows: (i) The proportion of contributions paid by the participating units to the personal accounts, which are under 45 years of age (with 45 years of age), is based on the number of annual salary incomes of 1 per cent in the personal accounts; the age of 45 years to retirement, which is based on the annual salary income of the individual, by 1.2 per cent in the personal accounts. (ii) Individual occupants who choose to be integrated into the accounts are classified in the personal accounts in accordance with actual contributions, in proportion to the contributions paid by the above-mentioned units and the proportion of the personal contributions accounts of the employee, who are under 45 weeks of age (including 45 years) to be transferred directly to the personal accounts; (iii) Retires are based on their annual pension or pension base and are converted into the personal accounts by 3.4 per cent. The above criteria are automatically adjusted to the proportion of individual accounts according to the actual age of the insured person. Article 33 (i) Medical fees incurred on medical expenses incurred by medical care at the point-by-point medical clinic, and for medicines generated by the purchase of pharmacies by the pharmacies; (ii) Medical costs below the standard of payment for the Integrated Fund; (iii) The standard of payment for the Integrated Fund is higher, with the maximum payment of medical expenses borne by himself; (iv) The highest amount of medical costs paid by the Integrated Fund; (v) Other costs under laws, regulations. The following medical expenses are not included in the coverage of the basic health insurance fund: (i) Payments from work injury insurance and maternity insurance funds; (ii) It should be burdened by third parties; (iii) The sudden public health incident is managed by the Government; (iv) Medical care outside the country (including the port area). Article 32 states of the Integrated Health Insurance Fund are as follows: (i) The basic health insurance fund raised in the year is based on the interest rate of the term deposits; (ii) Fund interest earned on bank deposits over the last year; (iii) Accumulating funds for depositing the financial exclusive recipient, which is not less than the amount of interest rate for the saving deposits over the three-year period. Article 33 Bengal and interest in the personal accounts of the insured person is owned by the individual and may be transferred and inherited by law. Article 34 provides for the establishment of a pre-primary system for the sound basic health insurance fund, the large-scale health insurance fund and the provision for medical support for civil servants, the financial accounting system, the system for overexpenditures of the Fund and the internal management system. The Integrated Fund for Basic Health Insurance, the Personal Account, which is managed by the IRS, is integrated into the same-tier financial exclusives, implements both income and expenditure lines, and does not crowd out any unit or individual. Article 335 is entitled to monitor the operation of the Basic Health Insurance Fund and to consult with the insured units and the health insurance agencies on the income and expenditure of their personal accounts. Article 36 establishes a monitoring mechanism for the Medical Insurance Fund. The human resources and social security, the financial sector, in accordance with their respective responsibilities, oversees the operation of the health insurance fund; conducts regular oversight of the payments and management of the funds of the health insurance institutions; and establish a board of health insurance funds, with the participation of government representatives, user unit representatives, health-care agencies representatives, trade union representatives and relevant experts, with full oversight. Chapter V Article 37 Basic health insurance for urban workers introduces a special chronic treatment system. Those who seek special chronic treatment should be in line with the prescribed scope of the disease. Article 338 treats special chronic illnesses in basic health insurance are divided into both A and B. There is no regular identification of persons who have been in contact with special chronic diseases. The regular identification of participants with special chronic illnesses. Article 39 requires the initial application for treatment of special chronic medical treatment by the insured person for medical treatment at the primary health insurance targeted hospitals, for example, the medical photocopy and the related inspection results, and for the medical practitioners of the targeted hospitals to complete the application for the treatment of medical treatment for basic health insurance workers in the town of Hand and Tary City, with the release of the medical care facility after the first instance of the PTS. Participating persons have two or more special chronic diseases, either in the meantime, to determine the identification of high-standard diseases. Article 40 After receiving the release of the declaration of the insured person by the insured health insurance agency, clinical medical experts should be organized to verify the uniformity of the material declared by the insured person and to issue the Special Chronic Psychotherapy Manual. Special chronic illness treatment has been identified and no longer declared within two years. Article 40. Special chronic treatment in category A and the treatment of special chronic diseases in category V is governed by the limits imposed by the disease. The Special Chronic Psychiatric treatment staff, according to confirmed illnesses, are paid by the Integrated Fund in proportion to the required rate of payment of medical expenses. The Special Chronic Psychiatric Medical Cost and the Inpatiental Treatment Costs and the Clinical Medical Costs for Clinics amounted to US$ 190,000. Chapter VI Article 42 provides for a management service agreement on the scope of services, service content, quality of services, cost-recovery approaches, and cost clearance and control methods, specifying the responsibilities of both parties and directing medical and pharmacies in accordance with the principle of sub-management, respectively. Medical fees payable by the Integrated Fund should be borne by the targeted unit; the part of the payment by the insured person is settled by himself and the targeted unit. Article 43 may select any targeted medical institution to purchase medicines at any targeted retail shop. Article 44 quantified medical institutions and customized retail pharmacies should use a computer-based health insurance management system that meets the standards of the central platform for the construction of gold works and health insurance. Article 42 flag districts integrate existing health insurance information resources in integrated areas, and implement the application of the Safeguard “Social Security Car” and “Final Work” and regulate the development of normative procedures, data interfaces, basic data and functional modules, to ensure system interoperability, resource sharing, and to implement the direct networking of institutions within the scope of this city with medical-targeted medical institutions. Chapter VII Legal responsibility Article 46 does not register health insurance by a person's unit, which is modified by a time limit for the accountability of the human resources and the social security sector; is not reformulated and the person's unit should pay more than three times the amount of the medical insurance pay, paying a fine of up to 00 million dollars for the head of the person responsible for it and other direct responsibilities. Article 47 does not pay the medical insurance fees in full and on time, and is paid or added by the human resources and social security sector for a period of time and from the date of the contributions, the five-year lags have been collected, and the amount of the contributory payment is less than three times the fine. Article 48 quantification units are charged with fraud, counterfeiting of material or other means for the medical insurance fund's expenditures, which are redirected by human resources and social security services, and are charged with a fine of up to five times the amount and distributing service agreements with the health insurance agencies; the competent and other direct responsibilities directly responsible personnel are eligible for operationalization, and the relevant authorities revoke their legal qualifications. Article 49 refers to medical insurance treatment by the insured person for fraud, forfeiture of the material or other means, and to the health insurance fund, which has been recovered by the human resources and social security sector, which receives a fine of more than five times the amount. Article 50 is one of the following acts by the health insurance agency and staff, which is rectified by their administrative authorities; liability under the law for the damage caused to the health insurance fund, the user unit or the individual; and disposal of the responsible person directly responsible and other persons directly responsible. (i) No statutory duties for health insurance; (ii) Unregistered the health insurance fund into the financial exclusive; (iii) Certified or refused to pay medical treatment on time; (iv) Disadvantaged or simulated medical insurance data such as payment records, access to health insurance records and personal rights records; (v) Other violations of the provisions of the health insurance law, regulations and regulations. Article 50 of the Medical Insurance Agency's self-imposed changes in the base, rate, resulting in a lack of receipt or multiple collection of health insurance payments, which should be paid or returned to the medical insurance fees that should not be paid by the human resources and social security sector; and the legal disposition of the direct responsible personnel and other persons directly responsible. Chapter VIII The medical treatment of persons with disabilities in the driguez, the old army and the denunciation is unchanged, and medical costs are addressed on the basis of the source of funds, which are difficult to fund and are addressed by the same-ranking people's Government. Article 53, paragraphs 1-6, provides for participation in the basic health insurance for the workers of the town, and the medical costs incurred are reimbursed by the civil service on the basis of the proportion of payments made under the basic medical insurance for the workers. Article 54 Human resources and the social security sector in the city can develop policies based on this approach that are followed by the approval of the Government of the city. Article 55 The implementation of the basic health insurance scheme for urban workers in the town of Hi and Huntland (No. 14 of the People's Government Order). |
